RESUMO
Background: Augmented reality (AR) guidance holds potential to improve transcatheter interventions by enabling visualization of and interaction with patient-specific 3-dimensional virtual content. Positioning of cerebral embolic protection devices (CEP) during transcatheter aortic valve replacement (TAVR) increases patient exposure to radiation and iodinated contrast, and increases procedure time. AR may enhance procedural guidance and facilitate a safer intervention. Objectives: The purpose of this study was to develop and test a novel AR guidance system with a custom user interface that displays virtual, patient-specific 3-dimensional anatomic models, and assess its intraprocedural impact during CEP placement in TAVR. Methods: Patients undergoing CEP during TAVR were prospectively enrolled and assigned to either AR guidance or control groups. Primary endpoints were contrast volume used prior to filter placement, times to filter placement, and fluoroscopy time. Postprocedure questionnaires were administered to assess intraprocedural physician experience with AR guidance. Results: A total of 24 patients presenting for TAVR were enrolled in the study (12 with AR guidance and 12 controls). AR guidance eliminated the need for aortic arch angiograms prior to device placement thus reducing contrast volume (0 mL vs 15 mL, P < 0.0001). There was no significant difference in the time required for filter placement or fluoroscopy time. Postprocedure questionnaires indicated that AR guidance increased confidence in wiring of the aortic arch and facilitated easier device placement. Conclusions: We developed a novel AR guidance system that eliminated the need for additional intraprocedural angiograms prior to device placement without any significant difference in time to intervention and offered a subjective improvement in performance of the intervention.
RESUMO
The inferior alveolar nerve block (IANB) is a dental anesthetic injection that is critical to the performance of many dental procedures. Dental students typically learn to administer an IANB through videos and practice on silicone molds and, in many dental schools, on other students. This causes significant stress for both the students and their early patients. To reduce discomfort and improve clinical outcomes, we created an anatomically informed virtual reality headset-based educational system for the IANB. It combines a layered 3D anatomical model, dynamic visual guidance for syringe position and orientation, and active force feedback to emulate syringe interaction with tissue. A companion mobile augmented reality application allows students to step through a visualization of the procedure on a phone or tablet. We conducted a user study to determine the advantages of preclinical training with our IANB simulator. We found that in comparison to dental students who were exposed only to traditional supplementary study materials, dental students who used our IANB simulator were more confident administering their first clinical injections, had less need for syringe readjustments, and had greater success in numbing patients.
Assuntos
Realidade Aumentada , Bloqueio Nervoso , Realidade Virtual , Humanos , Tecnologia Háptica , Nervo Mandibular , Gráficos por Computador , Bloqueio Nervoso/métodosRESUMO
Work on VR and AR task interaction and visualization paradigms has typically focused on providing information about the current step (a cue) immediately before or during its performance. Some research has also shown benefits to simultaneously providing information about the next step (a precue). We explore whether it would be possible to improve efficiency by precueing information about multiple upcoming steps before completing the current step. To accomplish this, we developed a remote VR user study comparing task completion time and subjective metrics for different levels and styles of precueing in a path-following task. Our visualizations vary the precueing level (number of steps precued in advance) and style (whether the path to a target is communicated through a line to the target, and whether the place of a target is communicated through graphics at the target). Participants in our study performed best when given two to three precues for visualizations using lines to show the path to targets. However, performance degraded when four precues were used. On the other hand, participants performed best with only one precue for visualizations without lines, showing only the places of targets, and performance degraded when a second precue was given. In addition, participants performed better using visualizations with lines than ones without lines.